Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003222316 |
---|---|
Provider Name | Melody Obrien |
First Address | Weymouth, MA 02190-1868 |
Second Address | Weymouth, MA 02190-1868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2014 |
Last Update Date | 08/07/2014 |